Latest / Becker’s Healthcare Podcast / Transforming Primary Care Access and Reducing Physician Burnout with Dr. Surendra Khera

Transcript

Transforming Primary Care Access and Reducing Physician Burnout with Dr. Surendra Khera · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - 400 speakers across four days of sessions that
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  - Not in the abstract, but against the real
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  - decisions they'll face heading into the next year.
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  - It's the kind of event you leave with
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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago,
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  - and come ready to do the hard thinking.
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
• 0:58
  - This is Laura Dirda with the Becker's Healthcare
• 1:00
  - podcast.
• 1:01
  - I'm thrilled today to be joined by doctor
• 1:02
  - Surendra Kara, president of the Cleveland Clinic Florida
• 1:06
  - Accountable Care Organization and vice chief for the
• 1:08
  - Primary Care Institute for the Florida Market of
• 1:10
  - Cleveland Clinic. Doctor Cara, it's a pleasure to
• 1:13
  - have you on the podcast today.
• 1:14
  - Hi, Laura. Nice to be here. Thanks for
• 1:16
  - having me.
• 1:17
  - Absolutely. Now I'm excited for our conversation. I
• 1:20
  - think it'll be,
• 1:22
  - a lot of fun just to learn about
• 1:24
  - what you're doing at Cleveland Clinic Florida and
• 1:26
  - how you're thinking about the future. But before
• 1:28
  - we dive in, can you tell us just
• 1:30
  - a little bit about yourself and your background?
• 1:32
  - Sure. Sure. So a lot of my background,
• 1:34
  - I,
• 1:36
  - in short,
• 1:37
  - trained in in India in med school, did
• 1:40
  - my postgraduate training in England, and then
• 1:43
  - in in The US was predominantly,
• 1:45
  - in the first half of my career,
• 1:47
  - on the inpatient side, immersed in inpatient
• 1:51
  - quality, safety, chief quality officer. And then in
• 1:54
  - the second,
• 1:56
  - migrated
• 1:57
  - slowly towards population health, value based care, and
• 2:00
  - primary care.
• 2:02
  - And so I've been with Cleveland Clinic, Cleveland
• 2:05
  - Clinic Florida for the last four years,
• 2:08
  - overseeing
• 2:09
  - their primary care institute in Florida and also
• 2:13
  - overseeing the ACO,
• 2:16
  - the treatment clinic,
• 2:18
  - what we call the treatment of Florida integrated
• 2:21
  - health care ACO.
• 2:22
  - I so I'm the president of that ACO.
• 2:25
  - So my role is work overseeing the institute
• 2:29
  - on the people, operations,
• 2:31
  - processes point of view. And then
• 2:34
  - as president of the ACU, I oversee the,
• 2:36
  - the value based care
• 2:38
  - and the care delivery structures and innovations that
• 2:42
  - supports,
• 2:44
  - supports that.
• 2:45
  - That's great to hear. And, you know, it's
• 2:47
  - such an important
• 2:48
  - aspect of the,
• 2:50
  - whole organization to oversee and look because I
• 2:53
  - know, you know, ACO
• 2:54
  - is so important and touches a variety of
• 2:57
  - different aspects of the whole enterprise and then
• 3:00
  - looking at, everything else that funnels into being
• 3:03
  - able to provide care is so critical.
• 3:05
  - Now could you give us just a a
• 3:06
  - quick state of the union? What's going well
• 3:08
  - this year, and what are you focused on
• 3:09
  - for the rest of 2026?
• 3:11
  - Yeah. No. Beautiful. So I think my
• 3:15
  - my journey into
• 3:17
  - primary care started with managing the complex patients
• 3:21
  - and in trying to work my way through
• 3:24
  - readmissions.
• 3:26
  - And one of the things I realized
• 3:28
  - during that time was
• 3:31
  - the the difficulty and challenges that primary care
• 3:33
  - faces with access.
• 3:36
  - So pretty much the last four years and
• 3:39
  - more so,
• 3:40
  - almost the completion of that happened this year
• 3:43
  - is the work that we have done on
• 3:45
  - access redesign in primary care.
• 3:48
  - And then we divided that that work,
• 3:51
  - Lauren, into
• 3:53
  - the just hiring of clinicians and expansion of
• 3:56
  - primary care, across Florida.
• 3:59
  - And, for example, we've now in my third
• 4:02
  - third year
• 4:04
  - sorry. Fourth year, we've now recruited over over
• 4:07
  - a 100
• 4:08
  - clinicians into the Prameka Institute across the region.
• 4:12
  - That has led to an absolute opening of
• 4:15
  - access,
• 4:17
  - But then we've done a lot of work
• 4:18
  - on access innovations.
• 4:20
  - We for example, we have a team called
• 4:22
  - the clinical access team that has now seen
• 4:25
  - over 20,000 visits, and this team
• 4:28
  - essentially manages same day access for patients when
• 4:31
  - they need it, complex patients when they leave
• 4:33
  - the hospital.
• 4:35
  - They also see patients when physicians, primary care
• 4:38
  - physicians, or or FMLA or leave,
• 4:42
  - and then then they manage their patients during
• 4:44
  - that time. So that team alone
• 4:47
  - has, has significantly improved our access in addition
• 4:51
  - to the recruitment and expansion of primary care
• 4:53
  - that Cleveland Clinic has supported.
• 4:56
  - We've continued to do innovations of primary care.
• 4:58
  - In a couple of weeks, we will launch
• 5:00
  - our first,
• 5:01
  - what we call,
• 5:03
  - primary care integrated model for care in the
• 5:05
  - evening and weekends. So we'll have our first
• 5:09
  - four primary care physicians who will work in
• 5:11
  - the evening, and they will be like any
• 5:14
  - other primary care physicians. They will have a
• 5:16
  - panel of patients,
• 5:17
  - but they will open access to our patients
• 5:20
  - in the evening and on weekends.
• 5:22
  - And they'll work in partnership with the data
• 5:24
  - in primary care physicians.
• 5:27
  - So it's innovations
• 5:28
  - in access like that. We redesigned our templates.
• 5:31
  - We've introduced
• 5:33
  - for for clinician retention.
• 5:35
  - We now have thirty minute templates that we
• 5:38
  - offer to primary care physicians.
• 5:40
  - As you know, primary care patients are very
• 5:42
  - complex.
• 5:43
  - So fifteen minute, twenty minutes
• 5:45
  - doesn't do justice to them. So we now
• 5:47
  - have well over 75 clinicians on the thirty
• 5:51
  - minute template, and
• 5:53
  - that has been a huge improvement, not just
• 5:56
  - in in clinician well-being, but the time that
• 5:58
  - they get to spend with the,
• 6:01
  - with the patient.
• 6:02
  - So if you if you add all of
• 6:04
  - this up,
• 6:05
  - I'll say the the big team for the
• 6:07
  - last four years,
• 6:09
  - which has almost reached
• 6:11
  - its perfection this year, but not still a
• 6:14
  - lot of work to do is is the
• 6:15
  - work around access.
• 6:17
  - So the net result is we've dropped new
• 6:19
  - patient wait days by almost 75%.
• 6:23
  - Two years ago, our patients were waiting months
• 6:26
  - to find a primary care physician, and now
• 6:28
  - that has dropped to under under, like, few
• 6:30
  - days. You can find a primary care physician
• 6:32
  - in some parts of the market.
• 6:35
  - We have,
• 6:37
  - you know, the
• 6:38
  - the number of visits that you get with
• 6:40
  - a primary care physician,
• 6:43
  - from three years ago to now, that has
• 6:45
  - doubled. So an average patient now gets double
• 6:48
  - the number of visits that they would get
• 6:50
  - three years ago with their primary care physician.
• 6:54
  - We've completed over seventy five percent of of
• 6:56
  - our patients who are eligible
• 6:58
  - at the annual wellness visits completed now. That
• 7:01
  - number was half a few years ago.
• 7:04
  - The net result is not just better patient
• 7:07
  - care, better access, but the second year in
• 7:09
  - a row, our ACO has had
• 7:12
  - a positive shared savings. So we are we
• 7:15
  - are seeing the numbers improve in in metrics
• 7:17
  - like appointments spent when, you know, when wanted.
• 7:20
  - Our turnover rate for clinicians, which was in
• 7:23
  - double digit, is now
• 7:24
  - in the low, you know, under 5%. So
• 7:27
  - we've we've and for the first time, as
• 7:29
  - an example, with two of our submarkets, we
• 7:32
  - have no openings in primary care, which we
• 7:33
  - never thought we would see today.
• 7:36
  - So we've recruited
• 7:37
  - successfully. Our turnover has dropped. We've done access
• 7:40
  - innovations.
• 7:42
  - All of that has resulted in in
• 7:45
  - in addressing those challenges of a very complex
• 7:48
  - patient population in Florida. You know, they're older.
• 7:51
  - About seven some markets, almost 72%
• 7:54
  - of them are on Medicare and managed Medicare.
• 7:58
  - So I think the
• 8:00
  - extremely proud of the work that we have
• 8:02
  - done around that, Laura.
• 8:04
  - That's amazing to hear and and very impressive.
• 8:06
  - And and, you know, love to to kind
• 8:08
  - of hear how you're thinking about that as
• 8:10
  - well.
• 8:11
  - Yeah. No. And I I'll tell you, we
• 8:13
  - we declared access not a scheduling issue.
• 8:17
  - Access is a safety issue. You know, I
• 8:18
  - came from the quality safety world.
• 8:22
  - Lack of access is almost a I consider
• 8:24
  - it a safety event.
• 8:26
  - So we say access is no longer a
• 8:29
  - scheduling problem. It's a health outcome strategy,
• 8:32
  - and that is deeply tied to our value
• 8:35
  - based agenda and our our the care that
• 8:38
  - we provide to our patients.
• 8:40
  - It's very proud of that workload.
• 8:43
  - Absolutely. And that's amazing to hear. And, you
• 8:45
  - know, when you think about that mindset shift
• 8:48
  - of,
• 8:49
  - having
• 8:50
  - access be a health outcome strategy tied to
• 8:52
  - quality, tied to everything else that you're looking
• 8:55
  - at for the patients, you know, it seems
• 8:56
  - like the team has been very innovative in
• 8:59
  - improving that access and finding ways that, they
• 9:02
  - can continue to, you know,
• 9:04
  - be,
• 9:05
  - innovative in,
• 9:08
  - redesigning care delivery and that whole process.
• 9:11
  - And I'm curious when you look at everything
• 9:13
  - that's going on, what are some of the
• 9:15
  - big headwinds that,
• 9:17
  - you're seeing right now or or that you're
• 9:19
  - facing as you're,
• 9:20
  - redesigning care and having the success?
• 9:22
  - How are you thinking about those headwinds in
• 9:24
  - preparing for them going forward?
• 9:27
  - Yeah. Oh, beautiful. So
• 9:29
  - I can tell you,
• 9:31
  - one of our biggest challenges is is a
• 9:33
  - national challenge, and then some of it is
• 9:35
  - very local to Florida.
• 9:37
  - The national challenge, I mean, if you saw
• 9:39
  - the study, for example, in JAMA a few
• 9:42
  - few weeks ago on the number of messages
• 9:44
  - that come to our primary care physicians.
• 9:47
  - So in the last five years,
• 9:50
  - the number of messages that come to primary
• 9:52
  - care physicians through portals, like MyChart messages and
• 9:56
  - and patient portals
• 9:57
  - has gone up by a 153%.
• 10:02
  - So that is if you see a primary
• 10:04
  - care clinic, you see a physical clinic. You
• 10:06
  - see primary care physicians.
• 10:09
  - What what no one sees is what what
• 10:11
  - I increasingly call the digital clinic. So running
• 10:14
  - in parallel to the physical clinic
• 10:17
  - is the digital messages that our patient has
• 10:19
  - are sending us, and that has gone up
• 10:21
  - by by a 153%.
• 10:23
  - Five years ago, they used to send about
• 10:25
  - point nine nine message or about one message
• 10:28
  - per patient, and now it's about two and
• 10:30
  - a half messages per patient.
• 10:33
  - We have not accounted for that. So,
• 10:35
  - nowhere,
• 10:36
  - I mean, we have inbox ologists. Increasingly, Cleveland
• 10:39
  - Clinic has ATPs who function as inboxologists in
• 10:42
  - managing these messages,
• 10:44
  - but we have not,
• 10:46
  - collectively,
• 10:47
  - strategically,
• 10:48
  - by way of policy,
• 10:50
  - payments, and measurements,
• 10:52
  - looked at what's happening in this digital
• 10:55
  - workload that has that has come out.
• 10:58
  - So the net result, for example, in
• 11:01
  - Cleveland Clinic primary care in Florida,
• 11:04
  - for every hour that a primary care physician
• 11:06
  - sees patients, they generate fifteen minutes of what
• 11:09
  - we call work outside of work. So that's
• 11:11
  - their task time,
• 11:13
  - time outside of scheduled hours.
• 11:15
  - So for every hour that they work, they
• 11:17
  - take fifteen minutes of work home. So if
• 11:19
  - you work a eight hour day, you've taken
• 11:21
  - about an hour and a half, two hours
• 11:23
  - of work home.
• 11:25
  - That is unaccounted for work. That is work
• 11:27
  - that primary care docs are doing on their
• 11:29
  - own time, on a weekends.
• 11:32
  - And if we don't find a solution to
• 11:34
  - that,
• 11:35
  - I think the the issues that primary care
• 11:37
  - faces with this they just continue to get
• 11:40
  - worse. I mean, we are projecting about an
• 11:42
  - 87, 90,000
• 11:43
  - primary care physician by 2037.
• 11:46
  - A lot of that is coming from the
• 11:48
  - burnout that they face, not just from the
• 11:50
  - physical work that they do, but the work
• 11:52
  - outside of work that they have to handle,
• 11:54
  - what we call the digital
• 11:56
  - work. So that is a real challenge, and
• 11:58
  - and different ways to solve that including,
• 12:01
  - treatment. So we have an inboxology
• 12:04
  - structure that is someone
• 12:05
  - sits and manages these in baskets for the
• 12:08
  - for the primary care physicians.
• 12:10
  - When they go on vacation, they come back
• 12:12
  - to about 65, 70% of the in basket
• 12:15
  - work done for them. So they're not sitting
• 12:18
  - after their vacation and going through hundreds of
• 12:20
  - messages.
• 12:21
  - But that is not all. I think there's
• 12:23
  - something I I I personally call a digital
• 12:26
  - corridor. I feel we need to design something
• 12:29
  - that runs in parallel
• 12:31
  - and in real time to primary care practices,
• 12:34
  - which I I I I just call it
• 12:36
  - a digital corridor. And in that, there are
• 12:38
  - inboxologists.
• 12:40
  - There are nurses. There are APPs who do
• 12:42
  - the work.
• 12:43
  - There are APPs and maybe even physicians who
• 12:46
  - do virtual visits so that the general sense
• 12:48
  - of pressure
• 12:49
  - that the clinics feel is shifted
• 12:52
  - into this this corridor.
• 12:54
  - So for example, in in our clinical access
• 12:56
  - team that we have,
• 12:58
  - which is
• 13:00
  - which I had mentioned earlier is an access
• 13:02
  - innovation.
• 13:03
  - One of the APPs there is is always
• 13:05
  - functioning as an in bask inboxologists,
• 13:08
  - and they're managing the in basket work that
• 13:10
  - comes out of the primary care practices.
• 13:13
  - I feel you need to you need to
• 13:15
  - expand that. I think we really need to
• 13:18
  - address this problem seriously, and not just in
• 13:21
  - care delivery redesigns, but also in policy. And
• 13:24
  - how do we account for this? You know,
• 13:25
  - we measure visits. We reimburse for visits. We
• 13:28
  - measure our views. We reimburse for our views.
• 13:31
  - But we we don't measure and we don't
• 13:33
  - count the digital workflow. So I think that
• 13:36
  - the policy changes need to be made and
• 13:38
  - payment changes need to be made and how
• 13:40
  - we do that.
• 13:42
  - And whether that is shifting some to the
• 13:44
  - patients or whether it is by the by
• 13:47
  - the peer
• 13:48
  - that needs to be determined. But but either
• 13:50
  - way, the digital aspect of our work needs
• 13:52
  - to be looked at seriously.
• 13:54
  - The other thing in Florida, I think, is
• 13:56
  - is this changing demographics.
• 13:59
  - I think,
• 14:00
  - we always knew Florida, I mean, was was
• 14:03
  - was the place for people to retire.
• 14:05
  - And now we anticipate
• 14:07
  - by, for example, by 2037,
• 14:10
  - the '20,
• 14:11
  - the CBO estimates that by 2034,
• 14:14
  - almost
• 14:15
  - sixty three, sixty four percent of our Medicare
• 14:17
  - patients would be on managed Medicare.
• 14:20
  - So the combination of the pressure that a
• 14:22
  - state like Florida fee feels,
• 14:24
  - managed Medicare and and Medicare patients
• 14:28
  - is a lot. So
• 14:30
  - category redesigns that supports,
• 14:34
  - these complex patients,
• 14:36
  - needs to be made. And I think I
• 14:38
  - don't think we have made enough practice optimization,
• 14:41
  - and support structure has not really changed a
• 14:43
  - whole lot in that direction.
• 14:45
  - A lot of that needs to happen.
• 14:48
  - We still function as a traditional primary care
• 14:50
  - assuming a very different tier mix
• 14:53
  - than a rising complexity
• 14:55
  - aging populations,
• 14:57
  - but I think we we need to very
• 14:59
  - intentionally need to make investment in that direction.
• 15:03
  - Those will be the two big that I
• 15:04
  - see,
• 15:06
  - you know, from the burnout prevention and then
• 15:08
  - then care we redesign that supports
• 15:10
  - the rising complexity and the demographic shifts in
• 15:13
  - our patients.
• 15:15
  - Absolutely. I think that makes a lot of
• 15:16
  - sense, and I appreciate you laying that out
• 15:18
  - so clearly for us because there's, you know,
• 15:21
  - so much, that it it relies on primary
• 15:23
  - care physicians being able to do what they
• 15:25
  - do in a critical role within the health
• 15:27
  - health care ecosystem. So to build that support
• 15:30
  - system around that digital work they're doing,
• 15:33
  - it's been great to see the start of
• 15:36
  - that. And then to your point, you know,
• 15:37
  - continuing to expand that and grow how you're
• 15:40
  - supporting their work as well.
• 15:42
  - And and as you've been going through this
• 15:44
  - transformation,
• 15:45
  - I'm curious
• 15:46
  - how,
• 15:47
  - easy or hard has it been to, you
• 15:49
  - know, put put people into these new positions
• 15:52
  - and roles,
• 15:53
  - as the digital workload has been increasing? Has
• 15:56
  - there it been well received, or or has
• 15:58
  - it taken some time to get people,
• 16:02
  - understanding how important this is and and what
• 16:04
  - they need to do in order to, make
• 16:06
  - sure the entire ecosystem works?
• 16:10
  - Beautiful question. So both. In a way, it
• 16:12
  - is it's
• 16:14
  - it was quite heartening to see that there
• 16:16
  - are people who want to do that work,
• 16:18
  - that there were,
• 16:19
  - there are,
• 16:21
  - clinicians who are willing to
• 16:23
  - be digital clinicians and managing basket and digital
• 16:26
  - visits and and support the practices in that
• 16:29
  - way. But on the other hand,
• 16:31
  - that space is,
• 16:33
  - as I said, the the structure there is
• 16:35
  - not well designed. The return on investments there
• 16:38
  - are not clear.
• 16:40
  - So so if if if if they are
• 16:42
  - doing work that has no tangible
• 16:45
  - business model tied to it
• 16:47
  - other than, you know,
• 16:49
  - offloading the clinicians in the physical space
• 16:53
  - and and retention,
• 16:54
  - then I think it just makes it harder
• 16:56
  - for them to understand the work and for
• 16:58
  - us to expand that work from the from
• 17:00
  - the business point of view.
• 17:02
  - I think if anything has come in the
• 17:03
  - way, of of of adoption of that, it
• 17:06
  - is that that lack of clarity or or
• 17:09
  - ambiguity that surrounds that space. But I think
• 17:11
  - from the adoption point of view,
• 17:14
  - I myself are quite pleasantly surprised on the
• 17:16
  - number of people who are
• 17:19
  - willing to embrace these kind of innovations in
• 17:21
  - primary care. So whether it is being a
• 17:23
  - digital,
• 17:24
  - primary care clinician
• 17:26
  - or a clinical access team member where you
• 17:29
  - provide access without being a primary care physician
• 17:33
  - or recruiting
• 17:34
  - the evening primary care physicians, which I thought
• 17:36
  - would be very hard, but we will manage
• 17:37
  - to we manage to recruit all of them
• 17:40
  - for the pilot to go live in two
• 17:42
  - weeks' time. I'm quite impressed really on the
• 17:45
  - willingness of the workforce and the people to
• 17:47
  - embrace
• 17:48
  - these schedule redesigns
• 17:50
  - and their willingness to jump in and do
• 17:52
  - it. So I'm very impressed there
• 17:54
  - and quite satisfying. I think they having worked
• 17:57
  - at the other side,
• 17:59
  - these clinicians find it very satisfying to do
• 18:01
  - the work that they know are helping their
• 18:04
  - colleagues in the physical space. For example, an
• 18:07
  - in basket,
• 18:08
  - clinician
• 18:09
  - or an APP
• 18:11
  - feels extremely satisfied. You know, that seventy, seventy
• 18:13
  - five percent of the work
• 18:15
  - could be done when someone is on vacation
• 18:17
  - and the primary care docs are coming back
• 18:19
  - to a much lighter workload than they used
• 18:22
  - to.
• 18:23
  - So I think it's a combination of of
• 18:25
  - very well embraced by
• 18:28
  - the clinicians who are doing it,
• 18:30
  - some ambiguity around
• 18:32
  - the the business modeling of that and the
• 18:34
  - expansion of that, and
• 18:36
  - then and then some gratification
• 18:39
  - in the work that they do in in
• 18:40
  - eventually preventing burnout and re and improving retention
• 18:44
  - in primary care.
• 18:45
  - Does that make sense?
• 18:47
  - Oh, absolutely. Yes. Thank you so much for
• 18:49
  - digging a bit deeper in there. And I
• 18:51
  - think, you know, that that's,
• 18:53
  - it can be such a big,
• 18:54
  - focus for a lot of the executive leadership
• 18:56
  - teams in terms of just making sure they
• 18:58
  - have everything set up in the right way
• 19:00
  - and are delivering the right messages that are
• 19:02
  - motivating the team and helping,
• 19:04
  - everyone grow and transform in the same way.
• 19:07
  - Now I'm curious. What is the next step
• 19:09
  - for you over the next two or three
• 19:10
  - years? Where do you see growth coming from,
• 19:12
  - and and what comes next?
• 19:15
  - Yeah. Beautiful. So I think the work on
• 19:17
  - access will just continue, Laura. That work is
• 19:20
  - our foundational work, but it is also the
• 19:23
  - future. So the future growth
• 19:25
  - will come from continuing to
• 19:28
  - sharpen access
• 19:30
  - both in the absolute sense of recruitment and
• 19:32
  - expansion,
• 19:34
  - but also innovations and access,
• 19:36
  - digital access,
• 19:38
  - and continuing to explore ways by which
• 19:41
  - the patients are seen
• 19:43
  - where they want to be seen and when
• 19:45
  - they want to be seen. And they are
• 19:46
  - not limited by the traditional designs of the
• 19:48
  - 8AM to 4PM primary care or 5PM primary
• 19:52
  - care.
• 19:53
  - So I think that work around access, access
• 19:55
  - innovation, digital access
• 19:57
  - is a huge team. And then try to
• 19:59
  - do that.
• 20:00
  - I feel very excited about
• 20:02
  - the prospect of AI and what that will
• 20:04
  - do for primary care and
• 20:06
  - whether it be in the space of
• 20:09
  - ambient Scribes, which we are now using, you
• 20:11
  - know, 90% of our primary care physicians are
• 20:13
  - now using Ambient Scribe. It's been life changing.
• 20:16
  - You know? We used to spend hours doing
• 20:18
  - our notes, and now we have a tool
• 20:20
  - that does that.
• 20:21
  - But, also,
• 20:22
  - what will be the next step in that
• 20:24
  - tool?
• 20:25
  - How will that aid us in our clinical
• 20:27
  - documentation,
• 20:28
  - in our billing,
• 20:30
  - in subsegmenting
• 20:31
  - our patients' risks? So we redesign the future
• 20:34
  - care delivery. It could be redesigned
• 20:36
  - around the complexity of the
• 20:38
  - patient. So I run a complex care clinic.
• 20:41
  - Could future
• 20:42
  - AI delivery tools segment the population? So based
• 20:46
  - on the design of the clinic,
• 20:48
  - those patients, will be seen. So feel very
• 20:50
  - excited about
• 20:52
  - the work in AI, the so the predictive
• 20:54
  - risk modelings of AI. Also,
• 20:56
  - the ability of AI to to help primary
• 20:59
  - care physicians just like the the scribe,
• 21:02
  - and we inscribe the work that they can
• 21:04
  - do in managing it in baskets. So there's
• 21:06
  - a pilot in Cleveland Clinic right now on
• 21:09
  - in basket responses,
• 21:11
  - using AI. So feel very, very excited about
• 21:14
  - how that'll
• 21:16
  - almost like AI could redesign
• 21:18
  - the entire flow of primary care and the
• 21:20
  - future of primary care. You The role that
• 21:23
  - that would take in our screenings, our annual
• 21:25
  - wellness exams,
• 21:27
  - our physicals,
• 21:28
  - questionnaires that we send out. So,
• 21:32
  - lots of spaces and areas where
• 21:34
  - both Cleveland Clinic and nationally, there there's room
• 21:37
  - for changes.
• 21:39
  - So I think the future will be I
• 21:40
  - feel very excited about the work on access,
• 21:43
  - the work on digital access, the work on
• 21:46
  - supporting primary care and making primary care,
• 21:49
  - not just something you know, traditionally, there's a
• 21:52
  - crisis in primary care, people leaving, but but
• 21:54
  - to switch it back into where people feel
• 21:56
  - engaged
• 21:57
  - in in the work that they they feel
• 21:59
  - traditionally, they feel very drawn to being primary
• 22:02
  - care physicians.
• 22:03
  - And I think a big portion of that
• 22:05
  - will be the work and access and and
• 22:07
  - then the role of AI.
• 22:10
  - That's amazing to hear. And, you know, it's
• 22:12
  - so incredible to think about what,
• 22:15
  - technology and AI has
• 22:17
  - allowed us to do in the health care
• 22:18
  - industry,
• 22:19
  - that wouldn't have even been imaginable a few
• 22:21
  - years ago. So it's, cool to have that
• 22:24
  - opportunity and then find those smart ways where,
• 22:27
  - clinicians are leveraging the technology to superpower them
• 22:30
  - and what they're doing for patients.
• 22:32
  - Before we wrap up here, I'm curious, who
• 22:34
  - do you admire as a leader, really, from
• 22:36
  - any industry and why?
• 22:39
  - Well, there are lots of people in the
• 22:41
  - industry I admire,
• 22:43
  - you know, and my my quality safety days,
• 22:46
  - Don Berwick. I was I absolutely love doctor
• 22:48
  - Berwick and the work and the the the
• 22:51
  - simplicity with which she delivered the message on
• 22:53
  - quality and safety.
• 22:55
  - But as as a leader, since my high
• 22:57
  - school days, Laura, I'm I'm a a big,
• 23:00
  - big fan of of Gandhi, Mahatma Gandhi.
• 23:03
  - And and coming from India, that's that's so
• 23:05
  - and then I can safely say the more
• 23:08
  - I read about Gandhi,
• 23:10
  - the more I'm convinced is is
• 23:13
  - if there's a leader in health care today
• 23:15
  - that that someone needs to look at it,
• 23:17
  - it is his teachings.
• 23:19
  - And
• 23:20
  - I think his idea of of
• 23:23
  - of equity, his idea of finding solutions that
• 23:27
  - works for everyone, not just for some,
• 23:30
  - His idea of,
• 23:32
  - of
• 23:33
  - he had a phrase that he said commerce
• 23:35
  - without conscience is a sin. I don't like
• 23:37
  - to use the word sin, but he used
• 23:39
  - it. He defined seven social sins, one of
• 23:42
  - which was commerce without a conscience.
• 23:45
  - Now we've seen a thousand percent increase
• 23:47
  - in equity money flow into
• 23:50
  - health care and primary care.
• 23:52
  - What does this mean,
• 23:55
  - for us? What does it mean for our
• 23:57
  - patients? You know, I
• 23:59
  - he said something very beautiful, Laura. He said
• 24:01
  - there's there's enough in the world for all
• 24:03
  - of us for what we need,
• 24:05
  - but there'll never be enough for our greed.
• 24:08
  - So so I I feel very drawn to
• 24:11
  - the teachings of
• 24:13
  - of of my middle school, high school learnings
• 24:16
  - of Gandhi, and now I keep reading it.
• 24:18
  - So
• 24:19
  - health care, I have a lot of heroes,
• 24:20
  - but but over time, I found the the
• 24:22
  - teachings of
• 24:24
  - of Gandhi very meaningful.
• 24:26
  - This
• 24:26
  - this call for tolerance,
• 24:29
  - nonviolence,
• 24:30
  - we need it more than ever.
• 24:32
  - He remains my hero.
• 24:34
  - Absolutely. What an inspiring
• 24:36
  - person to look to and and truly,
• 24:39
  - embody the things that,
• 24:41
  - Mahatma Gandhi
• 24:43
  - taught and lived out, during this time and,
• 24:46
  - you know, incredible inspiration for health care and
• 24:49
  - any industry in general. Thank you so much
• 24:52
  - for joining us on the podcast today. This
• 24:53
  - has been such a,
• 24:55
  - great conversation, doctor Kiera, and I'm looking forward
• 24:57
  - to speaking with you as well and seeing
• 24:59
  - you in person at our,
• 25:01
  - in November CEO, CFO roundtable. I think it's
• 25:04
  - gonna be, an incredible opportunity for us to
• 25:07
  - connect and and dig deeper into many of
• 25:08
  - the themes you talked about, and we'll just
• 25:10
  - look forward to seeing you there.
• 25:12
  - Beautiful. I'm very excited for that. Thank you
• 25:15
  - for this opportunity. Thank you for the November
• 25:17
  - opportunity, and hope to see you there.